Troubling mammogram news

May 24, 2007

AS A METHOD of detecting early cancers of the breast, mammograms are less than perfect, but still an effective and affordable test. For that reason, recent statistics showing a decline in the percentage of women undergoing these screenings are worrisome. Healthcare researchers should embark on new studies to explore the reasons behind the decline, so the trend can be turned around quickly.

According to a study by the National Cancer Institute and the Centers for Disease Control and Prevention, the rate at which women over 40 reported a mammogram in the past two years dropped from 70 percent in 2000 to 66 percent in 2005, the latest year for which data are available. That reversed an upward trend in the test between 1987 and 2000. The study found the decline was even steeper, from about 79 percent to 72 percent, among women aged 50 to 64, the group with the largest number of breast cancer cases in the United States. Breast cancer, the second-largest cancer killer among US women, strikes more than 200,000 women each year and takes the lives of more than 40,000.

The decline in mammograms could explain recent data on the reduced incidence of new breast cancer cases; with fewer tests there are fewer early cancers being detected. Another explanation for the drop in new cancer cases had been the falloff in the use of hormone replacement therapy by menopausal women, after it was discovered that this raised the risk of heart attacks, stroke, and breast cancer.

The authors of the study offer several possible explanations for the drop in women getting the test. It is possible that fewer women have insurance coverage. Another potential factor, the authors say, is that there might be fewer doctors doing the test, which could lead to long delays in women getting appointments. The authors referred to a recent Institute of Medicine report that speculated that low reimbursements by insurers and increased malpractice litigation against radiologists who read mammograms could be limiting the physicians providing this test.

Patient doubts, justified or not, about the effectiveness of mammograms might also be causing some women to forgo their annual screening, the authors say. The authors themselves have no doubt that the increase in screening "over time has made early detection of breast cancer more common and has helped reduce mortality from this disease."

If mammography is going to continue to save lives, researchers must find out why fewer women, especially those in the critical 50 to 64 age group, are turning away from it. An investment in such studies could shine a light on places that need mending in this country's catch-as-catch-can public health safety net.